Provider Demographics
NPI:1871510768
Name:GARY CHODOROFF MD
Entity Type:Organization
Organization Name:GARY CHODOROFF MD
Other - Org Name:BINGHAM PHYSICAL MEDICINE PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHODOROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-647-1470
Mailing Address - Street 1:30100 TELEGRAPH RD
Mailing Address - Street 2:SUITE 177
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4514
Mailing Address - Country:US
Mailing Address - Phone:248-647-1470
Mailing Address - Fax:248-647-1472
Practice Address - Street 1:30100 TELEGRAPH RD
Practice Address - Street 2:SUITE 177
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025
Practice Address - Country:US
Practice Address - Phone:248-647-1470
Practice Address - Fax:248-647-1472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGC046805208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP35930001Medicare PIN